Designing Effective Alcohol Warnings: Consumer Reactions to Icons and Health Topics

  • Anna H. Grummon
    Address correspondence to: Anna H. Grummon, PhD, Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston MA 20115.
    Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

    Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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  • Phoebe R. Ruggles
    Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
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  • Thomas K. Greenfield
    Alcohol Research Group, Public Health Institute, Emeryville, California
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  • Marissa G. Hall
    Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina

    Carolina Population Center, The University of North Carolina Chapel Hill, Chapel Hill, North Carolina

    Lineberger Comprehensive Cancer Center, The University of North Carolina Chapel Hill, Chapel Hill, North Carolina
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Published:October 26, 2022DOI:


      New warning labels for alcohol could reduce alcohol-related health harms. This study examined consumer responses to alcohol warnings with different designs.


      A national sample of 3,051 U.S. adults completed an online survey in August 2021. Participants were randomized to 1 of 4 warning topics (addiction, liver damage, early death, or colon cancer). Participants viewed 3 labels presented in random order: 2 types of warning labels (text-only and icon) showing a newly developed warning message about their assigned topic and a text-only control label showing a neutral message. Participants rated each label on effectiveness at discouraging alcohol consumption (primary outcome) and attention (secondary outcome) using 1-to-5‒point Likert-type scales. Participants also rated warnings with different causal language variants (e.g., “increases the risk of”, “contributes to”) and marker words (e.g., “WARNING”, “SURGEON GENERAL WARNING”).


      Both the text-only and icon warnings were perceived as more effective (average differential effects=0.79 and 0.86, respectively) and more attention grabbing (average differential effects=0.43 and 0.69, respectively) than control labels (all p<0.001). The icon warnings were rated as more effective and attention grabbing than the text-only warnings (average differential effects=0.07 and 0.27, respectively, both p<0.001). Although all warning topics outperformed the control messages, warnings about addiction were rated as less effective and attention grabbing than warnings about the other topics. A majority (60%) of participants selected “increases the risk of” as the most discouraging causal variant, and a plurality (47%) selected “SURGEON GENERAL WARNING” as the most discouraging marker word.


      New alcohol warnings could discourage alcohol consumption, especially if warnings include icons.
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